University of California San Francisco San Francisco, California
Riana B. Jumamil, MD1, Joann Kwah, MD2, Juan Lin, PhD3, Olga Aroniadis, MD, MSc4, Paul Feuerstadt, MD5, Michael Silverman, MD6, Marc Fenster, MD7, Karthik Gnanapandithan, MD8, Muhammad Sohail Mansoor, MD9, Abdul Bhutta, MD10, Lawrence J. Brandt, MD, MACG2; 1University of California San Francisco, San Francisco, CA; 2Montefiore Medical Center, Bronx, NY; 3Albert Einstein College of Medicine, Bronx, NY; 4Stony Brook University School of Medicine, Stony Brook, NY; 5Yale University, School of Medicine, Hamden, CT; 6Cleveland Clinic Foundation, Cleveland, OH; 7Mount Sinai Hospital, New York, NY; 8Yale New Haven Hospital, New Haven, CT; 9Albany Medical Center, Albany, NY; 10State University of New York Upstate Medical Center, Syracuse, NY
Introduction: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are recognized independent risk factors of colectomy, recurrence, sepsis, and mortality in patients with colon ischemia (CI). Previous research has been limited by small numbers of study patients and lack of data on comorbidities and analyses by stages of CKD. Using a large database of CI patients, we aimed to determine the impact of CKD by stage on short-term morbidity (hospitalization stay, surgical intervention, and 30-day readmission) and short-term mortality (30-day and 90-day mortality) to improve clinical insights in treating CI. Methods: We conducted a retrospective study using a database of hospitalized patients with CI at Montefiore Medical Center and Yale-New Haven Hospital from 2012 to 2018. Consecutive patients with biopsy-proven CI were identified and included if CKD data were available. Patients were categorized into five CKD stages (CKD 1, Glomerular Filtration Rate [GFR] ≥90 ml/min; CKD 2, GFR 60-90 ml/min; CKD 3, GFR 30-60 ml/min; CKD 4, GFR 30-15 ml/min; and CKD 5, GFR < 15 ml/min). Bivariate, multivariate, and survival analyses assessed potential predictors of morbidity and mortality. Results: 650 patients met inclusion criteria (Table 1). In Table 2, CKD 5 had the longest hospitalization stay (median 9 days, IQR 4-32, p < 0.001) and the highest incidence of surgical intervention (30.8%, p< 0.01) and 30-day readmission (32.5%, p< 0.001) compared to other CKD stages. In multivariate analyses: CKD overall (p=0.01) and peripheral vascular disease (PVD; OR=3.05, p< 0.01) independently predicted surgical intervention. CKD overall (p=0.001), coronary artery disease (OR=2.33, p< 0.001) and PVD (OR=2.54, p=0.02) independently predicted readmission. Male sex (OR=3.43, p< 0.01), PVD (OR=3.18, p=0.04), and surgical intervention (OR=6.53, p< 0.001) independently predicted 30-day mortality. In a survival analysis, male sex (HR=2.15, p=0.01) and surgical intervention (HR=3.04, p< 0.001) predicted 90-day mortality. CKD overall did not predict 30-day or 90-day mortality in multivariate analyses (Figure 1). Discussion: In CI patients, CKD overall predicted short-term morbidity, namely surgical intervention and 30-day readmission, but did not predict short-term mortality independent of other patient characteristics. CKD 5 had the worst outcomes overall, although there was no stepwise increase in adverse outcomes by increasing CKD stage.
Disclosures: Riana Jumamil indicated no relevant financial relationships. Joann Kwah indicated no relevant financial relationships. Juan Lin indicated no relevant financial relationships. Olga Aroniadis indicated no relevant financial relationships. Paul Feuerstadt indicated no relevant financial relationships. Michael Silverman indicated no relevant financial relationships. Marc Fenster indicated no relevant financial relationships. Karthik Gnanapandithan indicated no relevant financial relationships. Muhammad Sohail Mansoor indicated no relevant financial relationships. Abdul Bhutta indicated no relevant financial relationships. Lawrence Brandt indicated no relevant financial relationships.